Frehiwot Berhanu

Individual provider Active NPI Licensed Practical Nurse · Ridgefield, NJ

NPI 1104201821 · NPPES record last updated Jul 23, 2015

Key facts

NPI
1104201821
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
269332 (NY)
Practice address
781 Ravenhill PL
Ridgefield, NJ 07657-1309
Phone
(914) 564-0359
NPI assigned
Jul 23, 2015
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
269332NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 269332 NY Yes

Addresses

Primary practice location

781 Ravenhill PL
Ridgefield, NJ 07657-1309

Mailing address

781 Ravenhill PL
Ridgefield, NJ 07657-1309

Other providers in Ridgefield, NJ

All providers in Ridgefield, NJ · Licensed Practical Nurse in New Jersey

Sources for this page

Verify at the official NPI Registry.